Vestibular neuritis: Difference between revisions
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''Some sources consider vestibular neuritis and [[labyrinthitis]] to be the same thing (some differentiate based on auditory symptoms)'' | |||
==Background== | ==Background== | ||
*Benign, self-limited disorder associated with complete recovery in most | *Also known as vestibular neuronitis | ||
*Benign, self-limited disorder associated with complete recovery in most patients | |||
**Must distinguish from acute vascular lesions of the CNS | **Must distinguish from acute vascular lesions of the CNS | ||
*Pathophysiology | *Pathophysiology | ||
**May be viral or postviral inflammatory disorder affecting vestibular portion of CN VIII | **May be [[viruses|viral]] or postviral inflammatory disorder affecting vestibular portion of CN VIII | ||
* | *May differentiate from [[labyrinthitis]] which technically should have hearing loss | ||
* | *Prevalence peaks at 40-50 years of age | ||
==Clinical Features== | |||
*Acute, rapid onset of severe [[vertigo]] with [[nausea/vomiting]] and gait instability | |||
*Acute, rapid onset of severe vertigo | *[[Nystagmus]] | ||
*Nystagmus | **Unilateral, horizontal or horizontal-torsional that is suppressed with visual fixation | ||
**Unilateral, horizontal or horizontal-torsional that is suppressed | |||
**Does not change direction with gaze | **Does not change direction with gaze | ||
*Unlike BPPV and Meniere lasts several days and does not recur | *Unlike BPPV and Meniere lasts several days and does not recur | ||
== | ==Differential Diagnosis== | ||
*Cerebellum lesion | |||
**[[Nystagmus]] | |||
***Not suppressed with visual fixation | |||
***May be other than horizontal or horizontal-torsional | |||
***May change direction with gaze | |||
**[[Ataxia]] | |||
**Patient may have limb dysmetria, dysarthria, or headache | |||
**Head impulse test usually normal | |||
*Brainstem infarction | |||
**Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct) | |||
***Ipsilateral [[horner's syndrome|Horner's]], loss of corneal reflex, [[dysphagia]], contralateral [[numbness|loss of pain]]/temp | |||
{{Vertigo DDX}} | {{Vertigo DDX}} | ||
== | ==Evaluation== | ||
*See [[vertigo]] | |||
==Management== | |||
*Treat associated vertigo symptomatically | *Treat associated vertigo symptomatically | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
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*[[Labyrinthitis]] | *[[Labyrinthitis]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Neurology]] | |||
[[Category: | |||
Latest revision as of 15:18, 1 June 2022
Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)
Background
- Also known as vestibular neuronitis
- Benign, self-limited disorder associated with complete recovery in most patients
- Must distinguish from acute vascular lesions of the CNS
- Pathophysiology
- May be viral or postviral inflammatory disorder affecting vestibular portion of CN VIII
- May differentiate from labyrinthitis which technically should have hearing loss
- Prevalence peaks at 40-50 years of age
Clinical Features
- Acute, rapid onset of severe vertigo with nausea/vomiting and gait instability
- Nystagmus
- Unilateral, horizontal or horizontal-torsional that is suppressed with visual fixation
- Does not change direction with gaze
- Unlike BPPV and Meniere lasts several days and does not recur
Differential Diagnosis
- Cerebellum lesion
- Brainstem infarction
- Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
- Ipsilateral Horner's, loss of corneal reflex, dysphagia, contralateral loss of pain/temp
- Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
Vertigo
- Vestibular/otologic
- Benign paroxysmal positional vertigo (BPPV)
- Traumatic (following head injury)
- Infection
- Ménière's disease
- Ear foreign body
- Otic barotrauma
- Otosclerosis
- Neurologic
- Cerebellar stroke
- Vertebrobasilar insufficiency
- Lateral Wallenberg syndrome
- Anterior inferior cerebellar artery syndrome
- Neoplastic: cerebellopontine angle tumors
- Basal ganglion diseases
- Vertebral Artery Dissection
- Multiple sclerosis
- Infections: neurosyphilis, tuberculosis
- Epilepsy
- Migraine (basilar)
- Other
- Hematologic: anemia, polycythemia, hyperviscosity syndrome
- Toxic
- Chronic renal failure
- Metabolic
Evaluation
- See vertigo
Management
- Treat associated vertigo symptomatically